Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204E00000X | Oral & Maxillofacial Surgeon | MD.28043 | AL |
NPI | 1336385020 |
---|---|
Provider Name | Nathan Rias Brown |
First Address | Slidell, LA 70458 |
Second Address | Slidell, LA 70458 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/12/2008 |
Last Update Date | 20/07/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01586093 | (05) | MS |
051117632 | BCBS (01) | AL |
051117634 | BCBS (01) | AL |
051117635 | BCBS (01) | AL |
051117856 | BCBS (01) | AL |
051118675 | BCBS (01) | AL |
129132 | (05) | AL |
129133 | (05) | AL |
129134 | (05) | AL |
129135 | (05) | AL |
129136 | (05) | AL |
Z21003 | VIVA (01) | AL |